By Griselle Chernys
January 2013 marks the migration of all USA claims to The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10).
The ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993, replacing the ICD-9 coding system also developed by WHO in the 1970s. ICD-10 is used for resource allocation, payment reimbursement, and statistical health reporting. ICD-10 is used today in about 110 countries for cause of death reporting and statistics. Some 25 countries use the ICD-10 for reimbursement allocation in their health systems.
The USA ICD-10 allows for approximately 155,000 codes and enables the tracking of many new diagnoses and procedures compared to the ICD-9 with 17,000 available codes. Transitioning to this new and significantly expanded system has thus been understandably difficult. The United States will begin official use of ICD-10 on October 1, 2013, giving stakeholders about ten months to successfully transition. The United States will use Clinical Modification ICD-10-CM for diagnosis coding and Procedure Coding System ICD-10-PCS for inpatient hospital procedure coding.
All HIPAA “covered entities” must make the change; a pre-requisite to ICD-10 is the adoption of Electronic Data Interchange (EDI) Version 5010 by January 1, 2011. The implementation of ICD-10 has already been delayed. In January 2009, the date was pushed back by two years, to October 1, 2013 rather than a prior proposal of October 1, 2011.
The five major challenges facing transition that all payers, claims administrators and providers face can be summarized as follows:
1. Resourcing the Transition
The ICD-10 transition will require significant investment of time and money to ensure all systems that use and record diagnosis data are updated to comply with the expanded coding structure. It will be a complex and painstaking process, and many are worried about the costs involved.
For example, the ICD-9 system uses three to five digits for coding. The first digit can be either a number or one of two letters; the remaining digits are numbers. In contrast, the ICD-10 system has three to seven digits. These can be a mix of both numbers and letters. Many computer systems will need to be upgraded to accommodate this expanded coding.
The amount of time trainees are able to devote to learning the ins and outs of ICD-10 is a concern, as well as the expertise of the trainers. One of the more daunting issues is the depth of training needed to make sure all stakeholders understand how ICD-10 works and how to accurately submit claims to payers. The Centers of Medicare and Medicaid Services advise not to train for this change too soon to ensure that the training is retained by claims processors once it’s time for them to use it.
3. Maintaining two coding systems
Private payers, such as worker’s compensation plans, are not required to change to ICD-10. Therefore, providers may have to maintain both coding systems, depending on payers’ strategies. Two parallel systems puts a strain both on systems and on personnel who have to be competent in using both simultaneously.
4. Sustaining momentum
Most physician incentive programs for reimbursement use reporting based on Current Procedural Terminology (CPT) codes along with ICD-9 codes. To continue correct submissions, systems collecting data for incentive programs need to support ICD-10. Updating systems and ensuring that long-term reporting continues smoothly during the transition will be a concern.
5. Avoiding payment delays
Training physicians to code accurately, making sure that codes are entered correctly in billing systems and depending on payers to efficiently review claims under ICD-10 are all likely to lead to delays in payment. Many claims editing systems for major carriers are based on the old ICD-9 system and the CPT coding relationship to those codes. Payers will have to be very careful not to pay claims incorrectly or overpay claims due to improper coding of the claims.
PayerFusion’s claims technology addresses the necessary cross-walks and references to service our clients with the proper support through this transition. For more information, please review our services.